Marilyn Garcia, a senior nursing major, talks about her critical care nursing internship at the Glendale Adventist Medical Center.
What do you do at GAMC?
So far, I have spent three weeks working as a nurse intern—two on my home unit, the CICU (cardiac intensive care unit), and one on the ICU. I will work next week on the SICU (surgical ICU) and my last week will be back on the CICU. I also have been able to attend a few days of educational courses provided by the hospital educators including cardiac pharmacology, EKG lead placement and rhythm analysis, disaster preparedness, infection control, patient courtesy, and a class dedicated to the different nursing aspects of treating patients with type 2 diabetes mellitus.
What’s a typical day for you?
I begin each day by introducing myself to the night shift and day shift charge nurses (both are present for change of shift). I explain that my role on the unit is as a supportive staff member-nurse intern and that I am there to learn, assist, and interact with the patients and staff during their daily routines as well as during procedures and emergencies. I also let them know that I would like to be primarily partnered up with one nurse (and their two patients) for the shift, but that I will also be more than willing to assist other staff members during any downtime or when asked. Once my nurse is chosen for me (or a nurse has requested that I work with them), I shadow the nurse as they begin their day by receiving reports, assessing the patients, reviewing and administering medications, completing patients procedures, and updating the patient charts. Throughout the day I am able to ask questions about the intensive care medications that are being given, observe and assist scheduled and urgent procedures that are being performed, see the process of how a critical care nurse efficiently structures their day, and learn how to juggle the complicated nurse-doctor-patient-family relationship. I assist with every aspect of a patient’s care including physical assessment, medical administration, personal care, respiratory and physical therapy, emotional support, dietary requirements, and patient teaching. Some procedures that I have assisted or observed have included feeding tube placements, intubation, naso-gastric tube insertion, Dobhoff insertion, femoral arterial line placement, bladder scans, echocardiogram, x-rays, jugular vein central line placement and removal, central venous pressure set up and monitoring, deep suctioning of intubated patients, and restraint application and maintenance. I have transported patients to the radiology department for CT scans and to the catheter lab for cardiac stent placement, staying with them for the procedures. I have also been able to respond to three code blues and participate in one of them—one was a respiratory arrest and the other two were cardiac arrests. Neither of the cardiac arrest patients survived the code, despite the staff’s best emergency efforts. They were the first patients whom I have seen pass away. They were surreal experiences because of the intensity and focus required of the staff during the emergency interventions, but they were also very saddening experiences because of the trauma and loss the families experienced and expressed.
What makes this internship fun or interesting?
Everything that the nurses and I do is critically important to the survival and recovery of each patient. Always having that pressure to constantly maintain critical care nursing and patient knowledge, and to not only pay attention to the little things, but to stay two steps ahead of a patients’ ever-changing condition, is an exhilarating and rewarding feeling. Learning a mountain of new things everyday is so interesting and fun; and then being able to apply what I just learned right at that moment to help a critically ill patient is the really cool part!
What's the most challenging part?
The patient crises that occur multiple times each day. Whether it’s a rapid response, a code blue somewhere in the hospital (I respond to every one), or my own patient deteriorating, the most challenging part is making the right choices fast! I have encountered some of my own patients entering sudden cardiac, respiratory, and glycemic emergencies, and with the staff around me, I was always able to keep a clear mind and I was able to participate in the stabilization and recovery of those patients.
What knowledge and skills are you learning from the internship?
I am learning about the administration of intensive care medications, the nurse’s responsibilities and techniques for patient procedures, critical care time management, how each patient's pathophysiology relates to every aspect of their needs and care, common verbiage and acronyms that are used in critical care, in-depth patient assessment and charting, EKG rhythm analysis, ACLS procedures and the nurse’s role, and critical care independence and responsibility—which is a very important skill as a soon-to-be-new RN.
How did you hear about it?
I saw a flyer in the PUC nursing department.
How does the internship relate to your career goals?
Working as a critical care nurse, whether in the emergency department or intensive care unit, is my dream job. Everything I am seeing, learning, and participating in during this internship will be directly applicable to the area of nursing that I am currently pursuing.
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